CMS F-Tag · 42 CFR §483.25(b)(1), Skin Integrity · Quality of Care

Pressure Ulcers & Skin Integrity

Cited for F686? Here's what surveyors were looking for, how serious it tends to be, and how to structure a Plan of Correction that holds up.

Paul Richards, RN, MSHI·Founder, EasyPOC·✓ Clinically reviewed·Updated Jul 6, 2026

What the regulation says

42 CFR §483.25(b), Skin Integrity

§483.25(b)(1) Pressure ulcers. Based on the comprehensive assessment of a resident, the facility must ensure that: (i) A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual's clinical condition demonstrates that they were unavoidable; and (ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing.

Verbatim from the CMS State Operations Manual, Appendix PP.

What F686 actually means

F686 has a fork built into the regulation that surveyors always test: was the pressure ulcer avoidable or unavoidable? A resident can develop an ulcer and the facility can still be in compliance, but only if it did everything right, comprehensive assessment, prevention consistent with professional standards, and appropriate treatment. The citation turns on whether a step was missed. If a facility-acquired ulcer developed while preventive interventions were not implemented, or a known ulcer worsened without proper treatment, that is where F686 lands.

What surveyors check

The skin-risk assessment and whether it drove prevention, the preventive interventions themselves (repositioning, support surfaces, nutrition, moisture management) and whether they were actually carried out, and for existing ulcers, accurate staging and measurement, treatment orders followed, and healing progress. They evaluate whether a facility-acquired or worsening ulcer was avoidable given what the facility knew and did.

What most often triggers it

Facility-acquired pressure ulcer where preventive interventions were not implemented
Existing ulcer that worsened without treatment consistent with orders
No or inadequate skin-risk assessment driving prevention
Repositioning or support-surface interventions documented but not provided
Wound care not following physician orders or professional standards

How serious is it? Scope & severity

F686 often lands at actual harm (G) because a pressure ulcer is itself an adverse outcome, and it can reach Immediate Jeopardy (J, K, L) for severe, infected, or unstageable ulcers reflecting a serious care failure. Lower-severity D to F citations occur for prevention or documentation gaps caught before an ulcer develops or worsens.

Severity ↓ / Scope →

Isolated

Pattern

Widespread

Immediate Jeopardy

Actual harm

No harm, higher potential

No harm, minimal potential

The CMS scope & severity grid runs from an isolated no-harm gap (A) up through widespread Immediate Jeopardy (L). The level a surveyor assigns drives how urgent and far-reaching your Plan of Correction must be.

Example citation

F686 · Illustrative composite

Based on observation, record review, and interview, the facility failed to provide care to prevent pressure ulcers for Resident #4, assessed at high risk for skin breakdown. The care plan called for repositioning every two hours, but flow-sheet documentation and staff interview confirmed repositioning was not consistently performed, and the resident developed a Stage 3 pressure ulcer to the sacrum during the stay.

Illustrative example, not a real facility.

How to write the Plan of Correction

(1) Ensure the cited resident receives appropriate treatment now and reassess the wound and plan. (2) Identify scope: audit at-risk residents for prevention interventions and existing wounds for treatment per orders. (3) Systemic change: validate staff competency on skin assessment, repositioning, and wound care, and confirm the risk-assessment-to-intervention link. (4) Monitoring: audit at-risk residents and wound documentation on a defined schedule through QAPI. (Natural EasyPOC Clinical Procedure Mode fit: skin and wound care procedures plus competency checklists.)

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Common questions

What is F686?+

The CMS tag for skin integrity and pressure ulcers, under 42 CFR §483.25(b)(1).

What most commonly triggers it?+

A facility-acquired or worsening pressure ulcer where prevention or treatment fell short of professional standards.

How serious is it?+

Frequently cited at actual harm (G) and can reach Immediate Jeopardy for severe ulcers.

How do you respond?+

Treat the resident, audit at-risk residents, validate staff competency on prevention and wound care, and monitor.

This page is a compliance reference and does not constitute legal or clinical advice.